Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons.
Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons.
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DOI：
10.1136/bmjopen-2013-003153
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发表时间：
2013-08-13
期刊：
影响因子：
2.9
通讯作者：
Vickerman P
中科院分区：
文献类型：
--
作者：
Martin NK;Hickman M;Miners A;Hutchinson SJ;Taylor A;Vickerman P
注射吸毒者（PWID）是感染丙型肝炎病毒（HCV）的高危人群，但许多人没有意识到自己的感染。HCV干血斑（DBS）检测增加了成瘾服务机构和监狱的病例发现。与静脉穿刺相比，我们通过在专业成瘾服务机构或监狱提供DBS测试来确定增加PWID中HCV病例发现的成本效益。使用动态HCV传播模型的PWID患者成本效用分析，包括：疾病进展、诊断、治疗、注射状态、监禁和附加服务联系。英国。在专业戒毒服务机构或监狱进行脑起搏器测试。干预的影响是通过对原始数据的荟萃分析确定的。成本（以英镑计，1英镑= 1.60美元）和公用事业（质量调整寿命年，QALYs）与每个州相关，并确定增量成本效益比（ICER）。进行多元不确定性和单向敏感性分析。对于每个获得的QALY的支付意愿阈值为20,000英镑，成瘾服务中的DBS测试具有成本效益（每个获得的QALY的ICER为14,600英镑）。在基本情况下，假设在进出监狱时没有连续性的治疗/护理，在监狱中进行DBS测试并不具有成本效益（每获得QALY的ICER为59400英镑）。结果对HCV患病率的变化是稳健的；提高吸毒成瘾者对前吸毒成瘾者的治疗比率，大大降低了ICER（成瘾服务和监狱分别为每QALY增加4500英镑和3万英镑）。如果护理的连续性低于40%，监狱DBS ICER每获得质量质量低于2万英镑。尽管PWID的治疗率很低，但如果能确保治疗/护理的连续性，在专业戒毒服务和监狱中，增加病例发现可以具有成本效益。
People who inject drugs (PWID) are at high risk for acquiring hepatitis C virus (HCV), but many are unaware of their infection. HCV dried blood spot (DBS) testing increases case-finding in addiction services and prisons. We determine the cost-effectiveness of increasing HCV case-finding among PWID by offering DBS testing in specialist addiction services or prisons as compared to using venepuncture. Cost-utility analysis using a dynamic HCV transmission model among PWID, including: disease progression, diagnosis, treatment, injecting status, incarceration and addition services contact. UK. DBS testing in specialist addiction services or prisons. Intervention impact was determined by a meta-analysis of primary data. Costs (in UK £, £1=US$1.60) and utilities (quality-adjusted life years, QALYs) were attached to each state and the incremental cost effectiveness ratio (ICER) determined. Multivariate uncertainty and one-way sensitivity analyses were performed. For a £20 000 per QALY gained willingness-to-pay threshold, DBS testing in addiction services is cost-effective (ICER of £14 600 per QALY gained). Under the base-case assumption of no continuity of treatment/care when exiting/entering prison, DBS testing in prisons is not cost-effective (ICER of £59 400 per QALY gained). Results are robust to changes in HCV prevalence; increasing PWID treatment rates to those for ex-PWID considerably reduces ICER (£4500 and £30 000 per QALY gained for addiction services and prison, respectively). If continuity of care is >40%, the prison DBS ICER falls below £20 000 per QALY gained. Despite low PWID treatment rates, increasing case-finding can be cost-effective in specialist addiction services, and in prisons if continuity of treatment/care is ensured.
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影响因子：
11.4
作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
10.1136/bmj.c3172
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